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The success rate of becoming pregnant with the assistance of In Vitro Fertilization (IVF) world wide is around 30 percent. However in Sri Lanka it has increased to 40 percent.

It is indeed a great achievement to reach a success rate above the world success rate Dr.Madara Ralapanawe has reached a success rate of 37.5% in his first IVF cycle in IVF treatment.

IVF is available in Sri Lanka but many who seek treatment do not always ask the important and relevant questions, thereby leading to high expenses and failures.

Dr. Madara Ralapanawe, MD, Master in Clinical Embryology (Australia) spoke to The Morning Leader on what the most important questions are a patient should ask when seeking treatment as well as what the patient should look for at any IVF fertility clinic.

"It is important that there is transparency at any IVF clinic and that all of the patient’s questions are answered," said Dr Ralapanawe.

It is also important to find out the success rate of pregnancy in IVF of that particular clinic. Clinics will usually provide the patient with the world success rate but may be reluctant to provide their own success rate.

At the same time, if the wife’s age is above 40 years and husband’s age is above 45 years, then the success rate is usually lower than normal and this should be stated.

In Sri Lanka there is no watchdog that oversees the workings of such fertility clinics; such watchdogs however are very active in other countries.

Dr. Ralapanawe notes that it is indeed very important that such a body be set up in the country, so that there will be a list of IVF clinics and their respective success rates.

Vital questions that patients should ask a fertility clinic, include if they have back up systems for the following:

• sperm freezing facilities

• embryo freezing facilities

• a sperm bank and an embryo bank

There are several reasons why these facilities should be available and why asking these questions is important.

When carrying out IVF, and on the particular day that the eggs are to be recovered from the female, the male partner may also be under a lot of stress.

Owing to this stress there is a possibility that the husband may be unable to produce his sperm sample.

"This is why it is crucial that the clinic has the facilities to freeze sperm," explained Dr. Ralapanawe.

Having such a facility, the male partner beforehand can provide a sample of his sperm to be kept frozen, in the case where he may be unable to provide a sample on the day the wife’s eggs are being retrieved.

It may be a common case where the female may be prepared for IVF treatment even with the knowledge that there could be a failure, as the whole monetary cost may have already been paid.

However it should be made clear that if there is a failure, whether or not the patient will be refunded at least part of the money, and on what instances.

"This may not provide total comfort for the agony and depression in the event of a failure, however this may provide some comfort to the patient and may event allow them to go in for a second attempt at the treatment," highlighted Dr. Ralapanawe.

The other reason why IVF fertility treatment should have such facilities is because during the down regulation, induction of ovulation and egg recovery of the female partner, there are few occasions it is better to cancel the cycle rather than continue, knowing that it will fail. Such occasions are

1. If the female patient has not been down regulated.

2. If the female patient does not have three or more dominant follicles (eggs) on 7th day scan after eggs have been induced.

"There should be a minimum of three follicles, if not, the cycle should be cancelled. In a new cycle higher dosage of hormones will be administrated" said Dr.Ralapanawe.

3. In the event of ovarian Hyper Stimulation Syndrome (OHSS), where a female partner gets more than 20-30 follicles and the body serum estrogen level more than 25,000 pmol/L, the whole IVF cycle should be abandoned.

It is better to abandon because it could cause a life threatening situation, and the IVF could be a failure.

By abandoning the cycle the patient will not be in a life threatening situation at all. Because both enlarged ovaries can become normal with another injection if given within 10 days and the patient will get her normal menstruation too, said Dr. Ralapanawe.

It should be explained to the patient as to in what instances and what percentage of the total payment could be refunded, and when a new attempt at IVF should be started.

However if the serum estrogen level on the 10th day of ovulation induction along with mature follicles is between 18,000 and 25,000 pmol/L liter, the eggs will be retrieved and the embryos will be cultured.

"These embryos will be frozen and stored in a bank because when the body oestrogen is high, the womb is not ready to accept the embryos. So embryos will be transferred only two months later after preparing the womb (endometrium) by administrating progesterone" stated Dr. Ralapanawe.

[size=200][color=red][b]Guidelines a must for ivf treatment[/b][/color][/size]

[color=blue]By Shezna Shums[/color]
Morning Leader / 09Nov2005

[color=orange][size=109]The success rate of becoming pregnant with the assistance of In Vitro Fertilization (IVF) world wide is around 30 percent. However in Sri Lanka it has increased to 40 percent.

It is indeed a great achievement to reach a success rate above the world success rate Dr.Madara Ralapanawe has reached a success rate of 37.5% in his first IVF cycle in IVF treatment.

IVF is available in Sri Lanka but many who seek treatment do not always ask the important and relevant questions, thereby leading to high expenses and failures.

Dr. Madara Ralapanawe, MD, Master in Clinical Embryology (Australia) spoke to The Morning Leader on what the most important questions are a patient should ask when seeking treatment as well as what the patient should look for at any IVF fertility clinic.

"It is important that there is transparency at any IVF clinic and that all of the patient’s questions are answered," said Dr Ralapanawe.

It is also important to find out the success rate of pregnancy in IVF of that particular clinic. Clinics will usually provide the patient with the world success rate but may be reluctant to provide their own success rate.

At the same time, if the wife’s age is above 40 years and husband’s age is above 45 years, then the success rate is usually lower than normal and this should be stated.

In Sri Lanka there is no watchdog that oversees the workings of such fertility clinics; such watchdogs however are very active in other countries.

Dr. Ralapanawe notes that it is indeed very important that such a body be set up in the country, so that there will be a list of IVF clinics and their respective success rates.

Vital questions that patients should ask a fertility clinic, include if they have back up systems for the following:

• sperm freezing facilities

• embryo freezing facilities

• a sperm bank and an embryo bank

There are several reasons why these facilities should be available and why asking these questions is important.

When carrying out IVF, and on the particular day that the eggs are to be recovered from the female, the male partner may also be under a lot of stress.

Owing to this stress there is a possibility that the husband may be unable to produce his sperm sample.

"This is why it is crucial that the clinic has the facilities to freeze sperm," explained Dr. Ralapanawe.

Having such a facility, the male partner beforehand can provide a sample of his sperm to be kept frozen, in the case where he may be unable to provide a sample on the day the wife’s eggs are being retrieved.

It may be a common case where the female may be prepared for IVF treatment even with the knowledge that there could be a failure, as the whole monetary cost may have already been paid.

However it should be made clear that if there is a failure, whether or not the patient will be refunded at least part of the money, and on what instances.

"This may not provide total comfort for the agony and depression in the event of a failure, however this may provide some comfort to the patient and may event allow them to go in for a second attempt at the treatment," highlighted Dr. Ralapanawe.

The other reason why IVF fertility treatment should have such facilities is because during the down regulation, induction of ovulation and egg recovery of the female partner, there are few occasions it is better to cancel the cycle rather than continue, knowing that it will fail. Such occasions are

1. If the female patient has not been down regulated.

2. If the female patient does not have three or more dominant follicles (eggs) on 7th day scan after eggs have been induced.

"There should be a minimum of three follicles, if not, the cycle should be cancelled. In a new cycle higher dosage of hormones will be administrated" said Dr.Ralapanawe.

3. In the event of ovarian Hyper Stimulation Syndrome (OHSS), where a female partner gets more than 20-30 follicles and the body serum estrogen level more than 25,000 pmol/L, the whole IVF cycle should be abandoned.

It is better to abandon because it could cause a life threatening situation, and the IVF could be a failure.

By abandoning the cycle the patient will not be in a life threatening situation at all. Because both enlarged ovaries can become normal with another injection if given within 10 days and the patient will get her normal menstruation too, said Dr. Ralapanawe.

It should be explained to the patient as to in what instances and what percentage of the total payment could be refunded, and when a new attempt at IVF should be started.

However if the serum estrogen level on the 10th day of ovulation induction along with mature follicles is between 18,000 and 25,000 pmol/L liter, the eggs will be retrieved and the embryos will be cultured.

"These embryos will be frozen and stored in a bank because when the body oestrogen is high, the womb is not ready to accept the embryos. So embryos will be transferred only two months later after preparing the womb (endometrium) by administrating progesterone" stated Dr. Ralapanawe.[/size][/color]